July 2, 2010 — Children who experience serious adversities are at a greater risk for the onset and persistence of suicidal behavior throughout life, according to a new multicountry survey study.
Although exposure to many different adversities "are powerful predictors" for suicidal behavior in later life, sexual or physical abuse during childhood are the strongest risk factors of all, write lead study author Ronny Bruffaerts, PhD, associate professor of psychiatry in the Department of Neurosciences at Katholieke Universiteit Leuven in Belgium, and colleagues.
"Even after rigorously controlling for a broad set of variables, there was at least a threefold increase in lifetime suicide attempt and lifetime suicide ideation among individuals with a history of sexual or physical abuse," they note.
"The point is that childhood trauma has a systematic strong predictive value towards both worse mental and somatic health, as well as increased suicidal behavior," Dr. Bruffaerts told Medscape Medical News.
"Identifying those families at risk of problems, and offering help, may be a way of decreasing suicide around the world," he added in a statement.
The study is published in the July issue of the British Journal of Psychiatry.
Worldwide Suicide Rate Increasing
"Suicides are still one of the major causes of death worldwide," said Dr. Bruffaerts. He added that a report from the World Health Organization showed that the worldwide suicide rate has been increasing steadily since the 1950s.
"Most research on predictors of suicidal behavior focuses on mental disorders as main risk factors, but in the past years there have been some important findings that linked adversities with suicidality," he noted. Also, "the field of childhood adversities is especially an important field to study because its long-term effects have not been studied extensively."
For this study, the investigators evaluated data from nationally representative samples from the World Mental Health surveys. A total of 55,299 people from 21 countries in Africa, the Americas, Asia and the Pacific, Europe, and the Middle East were included.
All participants were interviewed in person about their childhood and whether they had experienced any of the following before they turned 18 years of age: physical abuse, sexual abuse, neglect, parental death, parent divorce, other parental loss, family violence, physical illness, and financial adversity.
Core diagnostic assessments of mental disorders were also made at that time, and the Composite International Diagnostic Interview 3.0 was used to assess lifetime suicidal behavior.
By using these surveys, "we were able to check whether this association [between adversities and suicidal behaviors] held for different countries, different cultures, and different contexts," said Dr. Bruffaerts.
Strong Associations Found
Results showed that 12.2% of the study participants had experienced the death of a parent, 8% had been the victim of physical abuse, and 6.9% had experienced family violence.
A total of 2.7% reported at least 1 suicide attempt, and 9.4% said they had thought about killing themselves.
Among those who had tried to kill themselves, 29.3% had been the victim of physical abuse, 24.8% had experienced family violence, and 14.5% had been sexually abused.
In both bivariate and multivariate models, the childhood adversities were associated with an increased risk for suicide attempt and ideation (odd ratio [OR] range, 1.2 – 5.7) and "the risk increased with the number of adversities experienced, but at a decreasing rate," report the study authors.
In the bivariate models, physical and sexual abuse had the highest odds for suicide attempts (OR, 3.7 and 5.7, respectively) and for suicide ideation (OR, 2.7 and 3.4, respectively). In multivariate additive models, "odds ratios decreased but none lost their statistical significance," the study authors write.
In addition, "associations remained similar after additional adjustment for respondents' lifetime mental disorder status," they add.
Finally, significantly strong associations were found between childhood adversities and suicide attempts in childhood (median OR, 3.8). These associations decreased during the teen years (median OR, 2.5) and in young adulthood (median OR, 2.0) before increasing again in later adulthood (median OR, 2.3).
"Specifically, a history of childhood sexual abuse was associated with a 10.9-fold increase in the odds of a [suicide] attempt between the ages of 4 and 12 years, a 6.1-fold increase in the odds of an attempt between the ages of 13 and 19 years, and a 2.9-fold increase among those between the ages of 20 and 29 years," write the study authors.
Associations Valid Worldwide
The study's overall finding of a strong association between childhood adversities and suicidal behaviors "was not really surprising because prior studies have also shown this," said Dr. Bruffaerts.
However, he noted that "important new findings" included the lifelong effects of childhood adversities, that their highest impact was in childhood and teen years, and that "bodily intrusive adversities" had a stronger impact than other events. But again, "this was not really surprising because it fits with impressions clinicians have."
"That we were able to show that the associations are valid for general populations worldwide was a major step ahead," added Dr. Bruffaerts. "I was [also] surprised...how prevalent childhood adversities actually are in the general population."
When asked about his plans for future research, Dr. Bruffaerts said that a valuable next step pertains to the question, "How can we change the suicidal process?"
"We know that the suicidal process is a treatable condition, but we don’t know exactly how many suicidal persons actually receive treatment," he explained. "In general, I think it is quintessential to generate prevalence estimates of mental disorders worldwide, their correlates and predictors, [and] the ways and why people with psychological problems seek help or not.
"In my opinion, this is an important way to gather data to build national and country-specific policies on," concluded Dr. Bruffaerts.
This study was funded by the US National Institute of Mental Health, the John D. and Catherine T. MacArthur Foundation, the Pfizer Foundation, the US Public Health Service, the Fogarty International Center, the Pan American Health Organization, the Eli Lilly & Company Foundation, Ortho-McNeil Pharmaceutical, GlaxoSmithKline, and Bristol-Myers Squibb. A list of all funders for the various countries' individual health surveys can be found in the original article. Dr. Bruffaerts and all but one of the study authors have disclosed no relevant financial relationships. Investigational team member Ronald C. Kessler reported several declarations of interest, which are listed in full in the original article.
Br J Psychiatry. 2010;197:20-27.